Monday, September 4, 2017

Most mothers in the US are tested for GBS during the final weeks of pregnancy. Like every test or procedure there is lots to learn before you decide to say yes or no thank you to your care provider. An excellent place to gather info is the Evidenced Based Birth site. I encourage you to read the section about Group B Strep carefully. Ask your doctor or midwife informed questions based on what you have read. Craft a plan of action. Be prepared to change it if your circumstances change. Don't forget to be proactive about repopulating your gut flora immediately after birth and include baby too.
Understanding Beta Strep; risks, tests, treatment
Many women have Beta Strep in the vagina. Many of those women if not given antibiotics will colonize their babies during the birth process. This means Beta Strep will be found on the skin and mucosa of the infant. BUT this doesn't mean the baby will necessarily become sick. Being colonized doesn't always equate with sickness.
Most babies who actually become ill with Beta Strep have been colonized in utero before birth and show signs of illness within hours of birth. Most babies who die from Beta Strep were born preterm.
Universal GBS screening followed up with antibiotics in labor for all women who tested positive has cut the number of neonatal Beta Strep deaths in half in the US. Very few babies actually die from Beta Strep but to cut this rate in half is significant. Whether this is from the Universal screening OR from the push to use antibiotics in labor is debatable. You'll see why I say this later.
Most babies who become ill with Beta Strep need NICU care for days or weeks; disrupting the bonding and breastfeeding process. This is a big strain on the family emotionally, physically and financially. This article doesn't have stats on if we have lessened our NICU admissions with universal screening and antibiotics in labor. It may be difficult to know because many babies are taken to the NICU because they MAY have Beta Strep. They are started on a course of IV antibiotics just in case. We can only know if they actually have it after a culture has grown which takes a number of days. So some babies are receiving NICU care and antibiotics who need it, and some are receiving it who don't.
To Screen or Not to Screen?
Different countries use different approaches.
U.S. uses Universal screening followed up with insisting on Penicillin during labor for all GBS positive women.
Great Britain uses Risk Based screening. So only women with certain risk factors are screened. I don't know how insistent they are about antibiotics but the language in their National Institute of Health and Social Care Excellence (NICE) documents use various levels of insistence depending on situation. They range from offered, to considered, to prescribed.
Here is their current thinking on why they choose Risk Based screening:
Dr Anne Mackie, Director of Programmes for the UK National Screening Committee, said:
"At the moment there is no test that can distinguish between women whose babies would be affected by GBS at birth and those who would not. This means that screening for GBS in pregnancy would lead to many thousands of women receiving antibiotics in labour when there is no benefit for them or their babies and the harms this may cause are unknown."
Dr. Mackie ties this decision to the microbiome which we'll discuss more in a minute. "The results showed that the infant microbiome was influenced by antibiotic exposure during labor, birth route (Cesarean or vaginal birth), and breastfeeding." These are the unknown harms she is referring too in the first quote.
New Zealand uses Risk Based Treatment rather than screen. Like the UK they have a set of risk factors that they use but rather than screen they simply begin antibiotic treatment in labor. They also seem to move from suggestion to insistence depending on risk factors present. They have a flow chart to show when to move women into different management. It appears that using THIS approach they too have cut their GBS mortality rate in half!
So which approach has the lowest baby mortality rate associated with it? New Zealand!
Comparing GBS Baby Mortality Rates
UK: .38 per 1000 babies born
US: .24 per 1000 babies born
NZ: .2 per 1000 babies born
Does this mean a risk based treatment approach is best? Not necessarily. Being associated doesn't prove a causal link. There may be more going on here; genetic factors, other labor management factors, or immediate newborn care factors, even a less virulent strain of GBS is possible. Other possibilities? Dietary changes and other cultural changes that could effect the bacteria present in the birth canal before or during labor. Bottom line? No one knows for sure yet.
The Good and Bad of Antibiotics
How does IV Penicillin in labor work? From the EBB link: "Penicillin rapidly crosses the placenta into the fetal circulation (at non-toxic levels) and can prevent GBS from growing in the fetus or newborn." Pretty straight forward. They are dosing not only you and killing your Beta Strep bacteria but also any already in your baby's system. Of course they are also killing all your good gut flora and your baby's too. This may be why there has been a rise in the rate of preterm babies dying from E. Coli sepsis. So to actually decide if we have done a good thing giving antibiotics in labor we would need to add baby mortality from Beta Strep to baby mortality from E. Coli and compare that rate to before we began using labor antibiotics. Didn't find those statistics in my research and it isn't in this link. Stumbled onto this possible connection with E.Coli rise in a different research paper.
Back to Dr. Mackie of the UK's concern about causing harm in some unknown way. Here is what Evidenced Based Birth says, "Research is needed to determine if there are any long-term effects associated with the temporary reduction in beneficial bacteria". Understanding the human microbiome is a rapidly evolving science. So far we know that some bacteria seem to turn on or turn off various genetic switches. Having evolved over thousands of years in a symbiotic relationship with the bacteria in and on our bodies we are linked right down to our DNA or gene expression. We are just beginning to understand this. It will be some time before we understand all of the impacts of this relationship with our body's flora.
We know different women carry different balances of various microbes. What the perfect balance is? No one has a clue yet. But good or bad, passing down your microbiota is part of your genetic inheritance to your children. We know there are properties in breastmilk designed to feed certain bacteria and resist the growth of other bacteria. So the body knows what balance is best. This is why breastfeeding can help mitigate the effects of the labor antibiotics.
Evidenced Based Birth says, "Research is needed to determine if giving probiotics to mothers and/or newborns can help lessen or reverse the impact of IV antibiotics on the infant’s microbiome." Well first we need to determine what all the impacts are. We know mother and baby have double the risk of developing thrush if she has antibiotics. Thrush impacts breastfeeding big time. Taking probiotics and breastfeeding appear over time to bring back the gut flora but it can take anywhere from a few weeks to a year. When do microbes effect gene expression? We don't know. Immediately after birth? During the first days or weeks? We don't know. Does it happen while in utero or in labor? We don't know yet. But there is bound to be a critical period for this. We just haven't a clue when it is because we don't even know yet how they are doing it.
Can You Lessen Your Risk?
Is there another way to lessen your baby's risk of GBS? EBB shows a study
that says, "probiotics (lactobacilli) may lessen your chances of being colonized with GBS." Wait a MINUTE! So perhaps we need to talk to moms about their DIET and how to lessen their potential Beta Strep load. In other words PROACTIVELY support women in bringing their bad microbe load of ALL types down as a way of circumventing the need for antibiotics by teaching them how to bring their body's flora into better birthing balance. The study EBB refers to shows that even putting probiotics onto panty liners can be helpful. What if moms did that starting after their first prenatal visit, and took probiotic capsules and ate and drank probiotic foods? What if we studied the difference between that group of women and the women being universally screened and automatically given Penicillin? What would we find at their 36 week screen? Would we prevent preterm births? Would we be able to maintain the same mortality rate from GBS? Or perhaps even do better? What would happen to the E. Coli death rate? I have no answers to these questions but they are IMPORTANT questions.
Final Thoughts
Please do not think I am telling you to blow off your GBS test. Please read all the research EBB presents. Consider carefully all the known risks, your current risk level (which can change), and the possibility of unknown risks. Please DO NOT use probiotics and dietary changes as a way to get a negative GBS test and then revert to old eating habits and discontinuing probiotics. Definitely read the article and talk carefully to your care provider.

Support & Guidance

The Journey Begins

Jennifer Stover

I have been a doula in San Luis Obispo County since Seth, my friend's son, was born in 1992. Witnessing his birth deepened my belief that birthing women need a strong, independent, educated member of their team supporting them in finding their own choices and voices.They need a caring experienced guide to stay by their side throughout labor. Later they need someone to provide clarity and wisdom as they process their experience. Over 100 births later these truths that crystalized for me two decades ago still are my guiding principles. This journal is my way of continuing to reach out to women to help educate and enlighten them about birth and to tell them I care about their journey.

Meet Me

Helping Families Grow

Read the lovely poem this Atascadero mama sent me after her successful unmedicated birth.

I'm a Member

The Breastfeeding Coalition consists of lactation consultants & educators, nurses, doctors and others passionate about ensuring babies from San Miguel to Nipomo get the best possible start through breastfeeding.

My Library

I have an extensive pregnancy, birth & parenting library in my home in Oceano for my client's.

Founding Member & First President of Birth & Baby Resource Network

Learn About this Important Community Organization

Class Reunions

Class Clients Speak

Local Resources

I highly recommend these local resources and the links below. All of them have been utilized by myself or my clients and found beneficial. I hope you do too. For businesses with a web presence check the Links List below!

Working in Other Communities

Client News!

Congratulations on the Birth of Their Second Child!

Jessica & Clayton are living in San Diego now. To see the birth of their new baby and read their story click on the photo.

Congratulations to Alisson & Matt on their growing family!

Alisson had a positive birth experience back home in Virginia.

Congratulations Amy & Matt Otsu

What a surprise to open the paper and see baby Emma is a rising national gymnastics star!

Congratulations to Lisa & Jeff Spence On your new addition!

They are currently living in Nicaragua.

Client News & Connections

This space will be used to keep my clients connected. If you have family news, business news, or you're moving and would like to let people know I'd be happy to post it. Do you have an internet presence? I will be posting links here. Just write me at jjmstover@sbcglobal.net or pick up the phone. I'd love to chat and catch up!

Jennifer Henderson is busy! Not only does she work for the Parent Particiaption Program taking kids on field trips around the county she also homeschools her kids, teaches for the adult school, teaches at Cuesta and writes travel stories. Check out all the great programs Parent Paticipation sponsors: http://ppp.slcusd.org/Home.html

What fun it was to open the Parent Participation site's Outdoor page and see a pregnant Colby Lindeman in a group of Tiny Hikers! She has told me several times how much she enjoyed this activity; meeting other moms, getting outdoors, getting excersize, doing the interacting with baby games.
http://ppp.slcusd.org/Outdoors.html

Colby Lindeman took her fitness expertise and turned it into an exciting new business helping moms get back in shape with their babies in outdoor settings. To see what they are up to: http://www.betterbodymommy.blogspot.com/

I spoke to Lisa Ann Dillon the other night. She is busy teaching at the San Luis Classical Academy, a support program for homeschoolers and teaching her oldest child at home. Hard to believe he is in Kindergarten already! To learn more about the Academy go to http://sloclassicalacademy.com/.

Chiropractor & past client, Leslie Kasanoff, invited me to an interesting nutrition lecture today that was held at Steven Tullius's chiropractic office (another past birth class client and homebirther). The lecture was about the importance of phytonutrients in our diet and how to obtain them. Of course I was most interested in how it relates to healthy pregnancies and births. I'll be writing about this topic soon. Check out Leslie's web site to learn more. http://lkasanoff.healthnewspodcast.info/

Shannon Len is expecting her first baby this month. I am so excited to support her at the new Santa Lucia Birth Center. Somehow she has managed to get ready for their new arrival while staying on top of her commitments to the art community and her jewelry business. To see her elegant jewelry designs: http://www.lendesignsjewelry.com/

It was fun to open the Tribune on Tuesday and see Carolyn Eicher and her lovely daughter Sabina donating kid's books to their local library. Sabina was born at General Hospital and it looks like all the hard work Carolyn put in that day has payed off!

Currently Carolyn is busy with a nonprofit she started called SLO Grown Kids. Their mission is to improve the health of the San Luis Obispo community by educating students and their families about healthful eating and the origins of food. Check it out at: http://www.slogrownkids.org/

Congratulations to Jenny Appell who is now teaching African Dance. She went back to performing with the local African Dance Troupe not long after each of her babies was born. My son and I had a lot of fun when we were studying Africa visiting her class. Her talented husband Rob, quilt artist and owner of The Cottonball in Morro Bay, has a new Endangered Species Quilt Project. To view the beautiful quilts and purchase patterns to support the animals: http://robappell.orthonormal.net/node/51

Speaking of dance Jenna Mitchell is back at work running World Rhythm & Motion Studio. They teach an eclectic group of dance classes from around the world. To see what might spark your interest: http://www.worldrhythmandmotion.com/

Congratulations to Amy Engleman who has bought a home in Templeton. Her son Chase is enjoying working on a pottery wheel at Santa Lucia school. He was inspired by a small pot my son Joe made when he was young which Amy purchased from Joe at a craft fair a long time ago. amy is very busy volunteering at the school. find out more: http://www.santaluciaschool.org/

Dawn Feuerberg besides keeping on top of Morro Bay's drinking water, being a mom of two now and continuing to teach Spanish at Cuesta has started her own business. Summers she is taking families south of the border on a family Spanish language & culture learning adventure! Interested? http://www.vivastudyabroad.com/

If you haven't heard about Acholi Beads yet please visit http://acholibeads.com/blog/ This is Jessica Connolly's brilliant business idea which combines business, women and social justice. Although she has moved to San Diego in our hearts she's still with us on the Central Coast.

A late congratulations and you go girl goes out to Kambria Doherty for her successful V-BAC at home of an over 10 pound baby boy. Dreams really can come true! And on her new business Kahuna Kids; an eco friendly kids store in Paso Robles. To see what they offer visit: http://www.kahunakids.com/Kahuna_Kids/Kahuna_Kids.htmlCongratulations to Erin Tullius for being chosen to apprentice with Jack Canfield, the founder of the Transformational Leadership Council. I can't wait to see what springs forth from that alliance. Update! Erin is an author! Check out her book about diet & health: http://mindoverfatterbook.com/

Baby Book

Welcome twins born vaginally! I am creating a photo album of past client's babies. If you wish to have your baby in my photo gallery please e-mail me at jjmstover@sbcglobal.net.